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Evaluating Practice Through Theories and Models, Essay Example

Pages: 15

Words: 4226

Essay

Introduction

In order to effectively contribute to quality improvement initiatives, it is necessary for nurses to implement nursing theories and models into practice. Applying evidence-based knowledge into practice has the ability to refine care in a manner that confers advantages for both the patient and the health care environment. As health care professionals, it is beneficial to evaluate existing theories and models to determine how these methodologies can be applied to practice. Furthermore, adding to and subtracting to these models to allow for further theoretical development allows for a more significant contribution to the nursing field. It is therefore valuable for nurses to regularly implement new strategies in their professional practice and to reflect upon their utility in new situations, or to suggest changes to existing models and theories as necessary.

Sister Callista Roy’s adaptation model of nursing and Lewin’s theory of change both contribute to an enhanced understanding of nursing practice. The adaptation theory allows nurses to gain a better understanding of how to provide care to patients by gaining a sense of the complex interactions that contribute to patient care. Meanwhile, Lewin’s theory of change can be used to effectively train nursing students, new entrants in the career, and to achieve professional development initiatives at the advanced level. While it seems that these theories are used to achieve distinct goals, they can be used together in order to achieve a more refined way of communicating with patients and implementing quality improvement initiatives.

The most effective nurses are able to draw from their understanding of practice in addition to their understanding of peer-reviewed literature in order to determine how to contribute to advanced nursing practice. Culminating a series of knowledge and applications and evaluating the strengths and weaknesses of a variety of methodologies will allow them to apply these skills in practice. Therefore, this study will evaluate the utility of Sister Callista Roy’s adaptation model of nursing and Lewin’s theory of change, providing information regarding their strengths and weaknesses. A case study will be provided to demonstrate how these models can be used in practice, including a discussion of how these two models can be used in conjunction to facilitate positive change in the health care setting.

Sister Callista Roy’s Adaptation Model: Description of Theory

Sister Callista Roy was born on October 14, 1939 in California and is a well-known nursing theorist that continues to work in this industry today. Sister Roy started her involvement in the field from simple beginnings, and started her involvement in nursing when she began to work as an aide in a hospital. Since Sister Roy was a highly charitable individual and wanted to dedicate her life to the field of nursing, she also joined the Sisters of Saint Joseph of Carondelet, of which she has been a member for over 40 years. Sister Roy’s influence to become involved in the nursing field came largely from her mother, who was a licensed nurse and taught her the values of nursing, encouraging her to incorporate these skills into practice. She is best known for the development of the Roy Adaptation Model, in which she considers that humans are holistic, adaptive systems. Thus, we can use a systems understanding to determine how humans interact with their environments.

Adaptation is typically thought of the ability of organisms to change over time. However, it also allows people to evolve in relation to their environment through the choices that they make (Butt & Rich 2010). Therefore, the adaptation theory allows for the growth and survival of individuals, in addition to happiness with respect to the environment (Butt & Rich 2010). Each individual part of a body has a purpose, but is meant to serve as a greater part of a whole (Roy 2012). Thus, various aspects of biological mechanisms can be used to gain a better understanding of human health. These aspects include biological changes which include the fluid, electrolyte, and acid-base balance in the body, in addition to interactions with bodily systems. Internal and external stimuli interact in order to create the physical manifestation of symptoms that we are able to observe. It is in part these changes that allow our bodies to interact with our environments. Since our external environment is a direct response, in most instances, to our external environment, the connection between these two factors is dramatic. An understanding of both of these components is necessary to ensure sufficient patient care is being provided.

The adaptation allows individuals to interact with both their internal and external environment. According to Roy, environment is defined as “every condition, circumstance and influence surrounding and affecting, particularly mutual, individual and group development and behavior” (Roy 2012). An understanding of the environment can be adequately used in order to help patient recover more effectively (Butt & Rich 2010). To apply this theory, nurses need to be aware of two concepts; first, there is a regulator mechanism that allows people to cope and adapt to their environment. These involve neural, endocrine, and perception-psychomotor processes to allow for perception, learning, judgment, and emotion (Roy 2012). The totality of the individual depends on their biological, psychological, and sociological existence (Roy Adaptation Model 2013). Since Sister Roy is a religious individual, she also emphasizes the spiritual relationships that individuals share with God. Since individual constantly interacts with these factors, it is important for nursing professionals to consider their importance in practice (Roy Adaptation Model 2013).

To understand how Roy’s Adaptation Model works, it is necessary to consider the functions of the regulator subsystem (RS) and cognator subsystem (CS). The RS gathers external stimuli and allows an individual to make the external state a more internal process, controlled by body systems. This is controlled primarily by the neurological and endocrine systems. The CS is the essentially opposite processes, and converts internal factors into more external ones by taking advantage of cognitive pathways (Creasia & Friberg 2011).

Lewin’s Theory of Change: Description of Model

Lewin’s theory of change consists of several steps. The purpose of the model overall is to remove incorrect knowledge of misconceptions from individuals and to change it to reflect correct knowledge or advanced understanding of nursing. To enact Lewin’s theory of change, the first goal that must be implemented is called “unfreezing” which provides nursing students with the ability to include new and altered practices into their personal nursing. Typically, a barrier to change happens when people believe that they do not need to build their understanding of the practice. This happens to many students, who have stunted growth in terms of their professional development because they are unwilling to change. Thus, individuals that are new to the nursing field need to unfreeze to ensure that their ability to contribute to nursing will increase. The need to change must involve both the nursing student or new nurse in addition to their preceptor to ensure that meaningful change can occur (van den Heuvel et al. 2013). An example of this phase of the change theory would be teaching students a new surgical method that differs from one they learned during their undergraduate training. To make sure that the “unfreezing” step occurs, it is necessary for them to show that they are willing to use the new techniques to reflect new needs in practice. This indicates that the students have become open minded with regards to learning.

The second step of Lewin’s change model is called “implementing change”. This follows the unfreezing stage and indicates that the students are ready to begin to incorporate their new knowledge into practice. This step involves the trainers providing these individuals with information pertaining to new techniques and standards. On the other end, the students will remember this information through repeated observation or study of these practices so that they are able to incorporate them into the skill set that they will regularly use when assisting their clients (van den Heuvel et al. 2013). Furthermore, it is challenging for these individuals to switch from their position as a student to their position as practitioner. The change step of the model allows this to occur.

The last step of Lewin’s model is known as the “refreezing stage” in which knowledge becomes more permanently retained. This step must be done correctly to make sure that the students who have acquired the knowledge have done so correctly. If not, it may be necessary to start the change process from the beginning. To ensure that the change was implemented correctly, the trainer will need to watch the new technique repeatedly in addition to practicing it many times as well. In some cases, this will also require a thorough understanding of when and why the technique should be used. Meanwhile, it is important for the student to continue to apply the technique to ensure that it stays locked in his or her muscle memory (van den Heuvel et al. 2013).

Case Study and Suggestions: Application of Lewin’s Change Theory and the Adaptation Model in Practice

Adaptation Model

It is important to consider that change is inevitable. One’s physical and psychosocial interactions along with the environment are constantly changing. These changes can impact an individual positively or negatively but this constant change becomes the driving force of human adaptation. As a consequence, the application of the adaptation model in addition to Lewin’s theory of change are both relevant practices in terms of improvement of individual and institutional nursing practice. Thus, Sister Callista Roy’s adaptation model of nursing and Lewin’s theory of change can be utilized to explain how nursing practice can be improved.

The adaptation model indicates that many different systems need to interact to make the totality that is the human body. Because energy to maintain a system, it is important to consider that the same is true for maintaining the physiology of the patient (Whetsell, Gonzalez & Moreno-Fergusson 2010). This energy can be gained externally, such as from psychological motivators, or internally, as influenced by the individual’s biology. If an individual’s system cannot respond appropriately to either external or internal stimuli, it can be said that this is a failure of their ability to adapt (Whetsell, Gonzalez & Moreno-Fergusson 2010). Therefore, nurses can play a more significant role in the care of their patients by paying additional attention to internal and external factors in the life of the patient that may be contributing to stress or other negative mental or physical states. It is therefore plausible for nurses to alter practice in a manner that takes these needs into consideration during the patient interview process in order to incorporate this understanding into the diagnosis and provided recommendations.

Humanism is defined as a shared idea and movement in philosophy and psychology that values the ability of humans to think logically and critically rather than operating strictly on policy. Meanwhile, veritivity is defined as “a principle of human nature that affirms a common purposefulness of human existence”. The adaptation theory therefore states that it is reasonable to incorporate the totalities that are made of parts that are united by a purpose and not just a cause-effect relationship when assessing patients. Thus, it is important for nurses to evaluate more about the patient than appears readily patient. In all nursing practices, this can be applied by forming a relationship with the patient. By understanding these individuals more thoroughly, nurses will be more able to provide these individuals with personalized care. The principle of veritivity is related to four aspects of human society, including the purpose of existence, humankind’s shared purpose, activity and creativity for the common good, and life sense value (Whetsell, Gonzalez & Moreno-Fergusson, 2010). Thus, by demonstrating to the patient that nurses care about their well-being, it will be easier to provide effective care.

While the adaptation model can be used in care primarily to improve interactions with patients, Lewin’s theory of change can be used to train nurses to implement this theory in practice. It could also be used to provide nursing students with a knowledge of surgical in addition to labor and delivery practices before they begin working with patients. A case study indicating the implementation of this model will be provided below.

Lewin’s Theory of Change

Nursing education deals with implementing a significant mixture of knowledge and theory. Before nurses can be allowed to participate in their career, this knowledge needs to be demonstrated to ensure patient safety. However, it is challenging for this to be done outside the context of practice because many nurses do not have the skills necessary to be a successful practitioner right away. All nurses are therefore required to gain a large amount of knowledge in different specialties in order to become more successful. However, these skills are often not possible straight out of nursing school. Therefore, it would be helpful for nurses to gain this experience in a different way.

Studies have shown that it is helpful for nurses to have a greater extent of hands on experiences in order to ensure that they are able to be better practitioners (Phipps et al. 2012). While many professionals acquire training during their college programs, these internships are often brief and do not allow the nurse to become fully involved in patient care. There is a need to hire more nurses, even though these individuals may not be ready to participate directly in care, so there is an incentive to create on site training programs to help these individuals. Doing so will allow these nurses to provide benefit to patients more immediately.

Simulations have been used to help nurses acquire this form of training in the past, but unfortunately, this has not been beneficial to a great extent because simulations are no replacement for real hands on practice (Arriaga et al. 2014). However, these simulations do not always provide nurses in training with the sensation of what working in the real life operating room is like. Thus, it would be preferable to provide labor and delivery nurses with an internship experience that will allow them to become trained in the necessary operating room skills before being allowed to work with patients independently.

It would be beneficial to incorporate Lewin’s change model into the training of new nursing professionals. This model incorporates three steps that allow students and professionals to incorporate new knowledge into their practices. This effort is expected to improve the quality of patient care because it will allow hospitals to work with more effective and trained nurses. It is expected that surgical and delivery nurses would not only gain more experience if Lewin’s change model is incorporated into practice, but the quality of patient care will increase as well. Thus, implementing this theory into practice is ideal for purposes of training.

This proposed training model demonstrates how Lewin’s theory of change can be made applicable in the field of practice. Training new employees and students is often challenging, but utilizing Lewin’s theory of change can prove a valuable component of this process.

Strengths and Weaknesses

There are many strengths and weaknesses associated with the adaptation model. First, it is important to consider that the adaptation model is a strength because it demonstrates that in order to achieve successful patient care, it is necessary to go beyond the symptoms and determine additional issues that might be present to help the patient achieve physical and mental health. As a consequence, the adaptation model can be defined as a patient-centered approach. While patient-centeredness is not the only intention of this theory, the model demonstrates that by caring for the patient as a whole, it is easier to determine the sources of ailment and provide recommendations that will be able to help the afflicted individual achieve health. Furthermore, it is important to emphasize the individual patient as the most important component of care, which holds true for individuals that promote the use of this theory.

A related weakness of this theory is that it is too encompassing of the various needs of the patient. Nurses are traditionally trained to search for symptoms and to use these symptoms as clues in order to reach a diagnosis. Therefore, it may be challenging for new nurses to deviate from this protocol in a manner that ensures that they are able to also focus on the physical ailments that they are searching for. Supporting patient health in a multi-faceted manner is beneficial, but it is important to do this in a way that will not detract from their primary health goals. In searching for a broader understanding of health, nurses that are inexperienced with the adaptation model may miss important evidence of health. This disadvantage could be avoided by providing adequate training, but many hospitals do not have the time and resources needed to design these programs for their staff members.

An additional weakness is that the model does not discuss the principle of humanism but mentions the principle of veritivity is to “allow nurses to meet the social mandate to help change the system by contributing to the common good via application of knowledge in practice” (Whetsell, Gonzalez & Moreno-Fergusson 2010). While this application makes sense in some instances, it would be valuable for the theory to directly discuss an application of humanism because this is a primary goal of the theory. Since nurses have observed this while practicing in the past, it would be valuable for this understanding to be amended in a manner that reflects this need.

Lewin’s theory of change is a strong model because it builds upon the psychological understanding of schemas. A schema is past knowledge that learners can build upon establish new understandings. As such, this change model requires that individuals reverse their incorrect schema to replace this information with correct or more relevant information. This model is beneficial to nursing practice because much of nursing education and experience revolves around the ability for the individual to contribute to their existing knowledge. As such, individuals with more years of nursing experience are considered to be more effective at their jobs, while individuals with less experience typically need more training. When mistakes are practiced, they often turn into habits. For both new and old practitioners, Lewin’s change theory can be used to remove the memory of mistakes and recreate them into strategies that will allow for proper practice.

A disadvantage of Lewin’s change theory is that it assumes that some form of change needs to be made in order to improve practice. In particular, there are some education strategies in nursing that require existing knowledge to be added onto instead of replaced. In these instances, Lewin’s change theory would be disadvantageous because the “unfreeze” step of the process wouldn’t apply. Instead, it would be necessary for this knowledge to remain frozen so that the change process could be adequately applied by drawing from this pre-existing knowledge.

Rationale

It is more ideal to apply an understanding of Lewin’s change theory to practice because it can allow for individual and institutional change to occur on a broader scale. Many nursing departments wish to implement a variety of new practices in order to facilitate quality improvement initiatives. Furthermore, many educators and managers wish to find more effective ways to train nurses to work more effectively and efficiently. Thus, Lewin’s change theory has the broadest scope of practice because it allows many different nursing goals to be achieved simultaneously.

Overall, it is necessary to provide nurses labor and delivery in addition to surgery with training that will allow them to gain a greater understanding of operating room functions. When new nurses enter the operating room setting, it is challenging for them to adapt to the fast paced practice model that is before them. However, this issue can be fixed by implementing Lewin’s change theory into practice. As a result, nurses will be more aware of the hands on techniques that they need to succeed, and it is plausible that their confidence will increase as well.

Conclusion

Nurses will benefit from an incorporation of both the adaptation model and Lewin’s change theory in practice. In particular, hospitals will be able to improve their standard of practice by incorporating Lewin’s change model into their practice.  While many techniques are taught to nurses during their traditional classroom training and internships, there is a need for hospitals to help their employees expand upon this knowledge. Reinforcing new skills under the leadership of trained professionals is a beneficial way to help “freeze” best practices for nurses in a variety of health care settings. Furthermore, the adaptation model is a beneficial theory to include in professional practice because it allows nurses to focus more significantly on the patient as an individual and to incorporate both their internal and external needs in order to provide them with quality care. Thus, it is plausible to combine these two understandings in order to achieve even more significant benefits in nursing practice.

As discussed in the case study, it is ideal to train individuals using Lewin’s theory of change because it supports the goals of hospital administration in addition to the quality improvement goals of the nursing team as a whole. It is therefore expected that this initiative will save the hospital money overall and enable the professional development of more confident nurses, which will boost patient satisfaction as well. Incorporation of both the adaptation model and Lewin’s theory of change will allow for the development of positive change in the health care community.

It will remain important for nurses to assess the strengths and weaknesses of nursing models in addition to providing feedback about how they should be modified or combined in order to contribute to patient care. The incorporation of the adaptation model and Lewin’s theory of change is one example of how nursing theories and models can be merged to add to a new understanding of nursing practice and research, but it will be necessary to continue investigating these matters into the future to ensure that the field of nursing is able to continue to evolve.

Bibliography

Andrews, H.; Roy, C. The Adaptation Model. Norwalk: Appleton & Lange, 1991.

Arriaga AF, Gawande AA, Raemer DB, Jones DB, Smink DS, Weinstock P, Dwyer K, Lipsitz SR, Peyre S, Pawlowski JB, Muret-Wagstaff S, Gee D, Gordon JA, Cooper JB, Berry WR. 2014, ‘Pilot Testing of a Model for Insurer-Driven, Large-Scale Multicenter Simulation Training for Operating Room Teams’, Annals of Surgery, vol. 259, no. 3, pp.  403-410.

Barone, S.H., Callista, R. & Frederickson, C.K 2008, ‘Instruments used in Roy adaptation model-based research: review, critique and future directions’, Nursing Science Quarterly, vol. 21, no. 4, pp. 353-362.

Butts, J. B., & Rich, K. L, 2010 ‘Philosophies and Theories for Advanced Nursing Practice’ [VitalSource Bookshelf version]. Available from http://digitalbookshelf.southuniversity.edu/books/9781449622541/id/ch02

Callista, R 2011, ‘Research based on the Roy adaptation model: last 25 years’, Nursing Science Quarterly, vol. 24, no. 4, pp. 312-320.

Callista, R 2011, ‘Extending the Roy adaption model to meet changing global needs’, Nursing Science Quarterly, vol. 24, no. 4, pp. 345-351.

Callista, R 2007 ‘Update from the future: thinking of theorist Callista Roy’, Nursing Science Quarterly, vol. 20, no. 2, pp.113-116.

Creasia, J.L. & Friberg, E.E. Conceptual foundation: the bridge to professional nursing practice. (5th ed). St. Louis, MO: Elsevier, Mosby, 2011.

Fawcett, J. 2005, ‘Using the Roy adaptation model to guide nursing research’, Nursing Science Quarterly, vol. 18, no. 4, pp. 320-323.

Frederickson, K 2011, ‘Callista Roy’s adaption model’, Nursing Science Quarterly, vol. 24, no. 4, pp. 301-303.

Lewin,K Frontiers of Group Dynamics: Concept, method and reality in social science, social equilibria, and social change. Human Relations, 1947.

Nursing theory. 2013. Available from http://www.nursing-theory.org/nursing-theorists/Sister-Callista-Roy.php Jones and Bartlett Learning. Retrieved from: samples.jbpub.com/9781449626013/72376_ch10_masters.pdf

Parker, M., & Lynn, C. 2006, ‘Nuring theories & nursing practice’. Available from http://www.r2library.com.southuniversity.libproxy.edmc.edu/resource/title/080361196X

Phipps MG, Lindquist DG, McConaughey E, O’Brien JA, Raker CA, Paglia MJ 2012, ‘Outcomes from a labor and delivery team training program with simulation component’, American Journal of Obestrics & Gynecology, vol. 206, no. 1, pp. 3-9.

Rambo, B. Adaptive Nursing. Philadelphia: W.B. Saunders Company, 1984.

Roy, C. The Roy Adaptation Model. In Riehl, J. P.; Roy, C. Conceptual Models for Nursing Practice. Norwalk: Appleton: Century Crofts, 1980.

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Roy,C. In Mosby’s dictionary of medicine, Nursing & Health Professions. Philadelphia, PA: Elsevier Health Sciences, 2012.

Shaw TJ, Pernar LI, Peyre SE, Helfrick JF, Vogelgesang KR, Graydon-Baker R, Chretien Y, Brown EJ, Nicholson JC, Heit JJ, Patrick JT, Gandhi T 2012, ‘Impact of online education on intern behaviour around joint commission national patient safety goals: a randomised trial’, BMJ Qual Saf, vol. 21, pp. 819-825.

Trempala, J., Pepitone, A. Raven, B. Lewinian Psychology. Bydgoszcz: Kazimierz Wielki University Press.

van den Heuvela M, Demeroutib E, Bakkerc AB, Schaufelia WB 2013, ‘Adapting to change: The value of change information and meaning-making’, Journal of Vocational Behavior, vol. 83, no. 1, pp. 11-21.

Whetsell, M.V., Gonzalez, Y.M., & Moreno-Fergusson, M.E. Models and theories focused on a systems approach. In Butts, J.B & Rich, K.L., Philosophies and theories for advanced nursing practice. Jones & Barlett Learning, LLC, 2010.

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